Insurance coverage of ketamine treatment
 

My doc told me insurance considers ketamine treatment experimental and is not covered. Is that true for all carriers or perhaps he was just
talking about my specific insurance.
Can people let me know how to proceed with ketamine and what the costs are?
thanks,
LogicWoman:confused:

No insurance doesn't cover ketamine treatments, he is right because it's considered experimental. Not enough numbers to show that it works consistently has come out from using it. I've never had it done, but another member here MSDrea had one awhile back and has 2 months pain free. I remember she mentioned needing to come up with another 2k for another infusion.

Hugs,

Karen

Not all Ketamine denied by insurance
 

It's not necessarily true that insurance companies deny payment for Ketamine infusions. We have Blue Cross/Blue Shield PPO and my wife had her 5-day in-patient low-dose infusion fully covered in Boston as well as outpatient infusions with a local physician here in Florida. In the first treatment in Boston her physician wrote a letter for the pre-approval for the inpatient treatment which outlined the studies, other failed treatments, and this treatment was generally as a last resort for pain relief. We didn't have to do this with the outpatient ones in Florida which were done by a BC/BS preferred provider. So, even though it has been generally considered experimental, the current clinical trials and documentation has helped get it recognized by insurance companies.

BigBug,
So after the her doctor sent a letter siting in outline the studies done, other failed treatments your wife had done & how this was generally used as a last resort for RSD pain relief they actually caved in & paid for it???? WOW I am truly amazed. Makes me sure wish I had insurance other than Medicare right now for sure. I don't think they would cave in for any reason. Not until it was paid for alot by other insurances. Unless...........What most insurance companies do is bargain to pay medical facilities, doctors & other types of medical professionals etc as close as they can to what Medicare pays for the same medical facilites, doctors & other professionals. So if one could site, like I said, all the above that you did plus what private insurance companies are allowing this procedure to be done they just might pay for it. Also, BigBug what type of doctor did the letter writing for your wife?? Was he a Pain Management or Neurologist or other type of doctor? That also would be worth knowing.

So is there anyone else out there that has had this procedure, 5 day inpatient Ketamine infusions, paid for by their insurance company. Doesn't matter if they have their insurance through their work or they pay for it on their own, it is considered to be private insurance. Anyway if your insruance has paid for this procedure we might all benefit from knowing this information. That way we can maybe get not only Medicare to pay for this but get other private insurance companies to ante up also. What do ya'll think???

It is worth a try right???

DebbyV

I have had 3 - 5 day low dose infusions each with boosters and my insurance paid for it, outside of deductable and copay's. I really could not tell you why some get paid for and some don't. Over the time that I had the treatments I had 2 different insurance companies also. Good Luck...

Gabbycakes

All the insurances are different.

BC/BS PPO is a pretty liberal carrier.

But some are quite stingey.... It is always a good idea to
try the prior authorization procedure outlined in your policy.

It has been my experience that HMO's are the most likely to
decline, even with a doctor's prior approval request.

Hi everyone,

I am new here and just following yor thread. I have experienced denials from my insurance also BC/BS HMO I have another name for them too! My husband is employed by local hospital where I have been treated. Nurses in general say that the insurances automatically spit out a denial without any consideration or even looking at it for that matter. The second response sent gets put in another slot. The nurses told me to pe persistant. I did an appeal for out of network surgery and won. It is dificult to do because I was heavily medicated and in a lot of pain at the time. I made points at the insurance of how they approved my SCS trial in network that cost 37000.00 and it was not guaranteed to work, but they would not approve a 12000.00 surgery that was likely to work or hekp considerably. I also faxed 3 hrs of medical records, 2 drs letters and photos of my RSD. The appeals specialist said i won because they had so much info. The appeals physician in midwest wrote a very short you better reverse your denial. Insurance co's are only willing to agree when they feel you might have something to bring against them. When they turn you down they are hoping that you will go away and sadly they win to much.

If anyone would like to see my letter or have a copy I would be more than happy to share.

I hope this was helpful. Knowone should have to go through this process.

fondly
debbie

Thanks for all the great information. Does any one know if ketamine has ever, or is in the process of, being tested in clinical trials?
thanks,
LogicWoman

A few years ago I spoke with the German physician who conducted the low dose trials along with the deep coma treatment. Based on his findings at that time he had decided to stop the low dose trials, he found that there was limited benefit to the patients and it required ongoing booster treatments. He advised me against it, instead he recommended lidocaine infusions before trying the deep coma option. I have a copy of his published findings some where in my files which I can send to you if you pm me with your email. I know further research has been done in the USA and elsewhere but I am not aware of any published findings. Lidocaine definitely has far less side effects than ketamine and is quite effective.

MsL

Question about BC/BS coverage for Ketamin infusions
 

Hi, I also live in Florida and I haven't found any doctor other than Dr. Kirkpatrick at the research center that even does this treatment..Could you please let me know the doctor that accepted BC/BS PPO, that is exactly what I have but because I am not able to go back to my job I may lose my insurance in 3 months. Thank you, Pepper PS...I live near Tampa